Hand-sewn Bowel Anastomosis: The Only Correct Choice. Ashok Babu, M.D. Department of Surgery University of Colorado

Size: px
Start display at page:

Download "Hand-sewn Bowel Anastomosis: The Only Correct Choice. Ashok Babu, M.D. Department of Surgery University of Colorado"

Transcription

1 Hand-sewn Bowel Anastomosis: The Only Correct Choice Ashok Babu, M.D. Department of Surgery University of Colorado

2 Outline History Trial data in specific applications Colorectal Ileocolic Esophagogastric Trauma Time efficiency Cost efficiency

3 History Sutureless anastomosis (compression) 1826: Donaus Hand-sewn double layer 1882: Connel Hand-sewn single layer 1887 Halsted, 1922 Schiassi, 1951 Gambee, 1975 Matheson Stapled 1908 Hungary Hultl Early 1960 s Moscow Late 1960 s USA Ravitch

4 The Controversy

5 Colorectal Meta-analysis Complication 13 PRCT comparing handsewn vs stapled Leak No study independently showed significant Mortality difference in leak rate, stricture, cancer Stricture recurrence, or mortality Tech Problem Odds Ratio Conf. Interval Cancer rec Wound infection ODDS RATIO LESS THAN 1 FAVORS STAPLED ANASTOMOSIS MacRae et. al. Dis Colon Rectum 1998.

6 Colorectal Meta-analysis Complication Cochrane Review 9 Stapled PRCT. Sewn 1233 patient CI 622 stapled Leak 611 handsewn 6.3% 7.1% NS Mortality 2.4% 3.6% NS Indications included cancer, diverticulosis, Stricture prolapse 8% 2% 1.2%- 8.1% Mostly EEA but some end to side Wound infection 5.9% 4.3% NS Lustosa et. al. Cochrane Database

7 Colorectal Summary No difference between stapled vs. handsewn except for: higher stricture and technical mishap rate in stapled Average of 8 minutes longer time for handsewn (from one study)

8 Ileocolic Very few trials Largest PRMCT by Kracht et. al. 440 patients RADIOLOGIC leak detection Randomized to side/side stapled (106) or 4 types of sutured End to end interrupted/continuous (84/77) End to side interrupted/continuous (82/91) 8.3% leak rate in all handsewn groups vs 3% stapled Not significant in subgroups Kracht et. al. Int J Colorectal Dis. 1993

9 Ileocolic Crohn s Retrospective study End to End Wide side/side Wide lumen side to side stapled (69) compared to Handsewn end to end (69) Stricture/fistula Hypothesis: wide lumen 26% leads to less 4% stasis, p=.017 pressure, and ischemia resulting in lower leak, stricture, and recurrence rates Recurrence 57% 24% p=.04 Munoz-Juarez. Dis Col Rectum. 2001

10 Ileocolic Crohn s Retrospective study Wide lumen side to side stapled (71) compared to Handsewn end to end (55) Leak Rate 14.1% end to end vs 2% (p=0.02) Resegotti. Dis Col Rectum

11 Ileocolic Summary These studies compare anastomotic configuration AND stapled vs. handsewn technique simultaneously This makes the data uninterpretable

12 Esophagogastric anastomosis Meta-analysis 5 PRCT s Circular stapler vs. end-end hand-sewn All patients underwent esophagectomy for cancer and randomized to 2 techniques No significant difference in leak or stricture rate, though trend in favor of hand-sewn RR Mortality 0.45 in hand-sewn (p=0.05)

13 Trauma Suture is better Retrospective cohort Harborview, Seattle Small bowel and large bowel, blunt and penet. Hypothesis: bowel edema in trauma renders fixed depth staple dangerous Looked for clinically significant leaks Stapled Sewn p n Leak 4 (7%) 0.04 IAA 6 (10%) 2 (3%).13 Fistula 1 1 Brundage et. al. JOT 1999

14 Trauma Suture is better Retrospective multicenter Small bowel and large bowel, blunt and penet. Stapled Sewn p n Leak IAA Fistula 3 2 NS Brundage et. al. JOT 2001

15 Trauma No Difference Retrospective cohort Minnesota group Small bowel injury only, blunt and penet. Compared resections with handsewn vs. stapled reconstruction Stapled Sewn p n Leak 0 3 NS IAA NS Fistula 2 0 NS Witzke et. al. JOT 2000

16 Trauma No Difference Prospective multicenter nonrandomized Penetrating colon injuries Leaks defined as req. draining or operation Stapled Sewn p n Infection 26.6% 20.3% 0.3 IAA 20.3% 15.6% 0.39 Leak 6.3% 7.8% 0.69 Mortality 3.8% 3.1% 0.8 Demetriades, Moore et. al. JOT 2002

17 Shape Technique Technical Location Indication Heterogeneity Stapled Handsewn End-to-End End-to-Side Side-to-Side Circular Linear Continuous Interrupted Tension Blood Supply Technical execution Esophagus Stomach Small bowel Large bowel Cancer IBD Trauma Infection 2 nd layer No reinforcement Single Layer Double Layer

18 Operative Time 1 st Author Design n Stapled (min) Sewn (min) George PRCT Didolkar PRCT McGinn PRCT Scher PNRT Adloff Retro

19 Single surgeon experience Bruno Cola, Bologna, Italy

20 Cola. It. J Coloproct Cost Analysis (Euros)

21 Cola. It. J Coloproct Cost Analysis (Euros)

22 Conclusion No solid evidence for improved outcomes or decreased operative times with stapled anastomosis of any type In an era of morbidly expensive healthcare, the use of staplers for GI anastomosis should ONLY be considered in the setting of special circumstance (laparoscopy, etc.)

Understanding Laparoscopic Colorectal Surgery

Understanding Laparoscopic Colorectal Surgery Understanding Laparoscopic Colorectal Surgery University Colon & Rectal Surgery A Problem with Your Colon Your doctor has told you that you have a colon problem. Now you ve learned that surgery is needed

More information

Cervical triangulating stapled anastomosis: technique and initial experience

Cervical triangulating stapled anastomosis: technique and initial experience Original Article Cervical triangulating stapled anastomosis: technique and initial experience Jingpei Li 1 *, Yaxing Shen 1 *, Lijie Tan 1, Mingxiang Feng 1, Hao Wang 1, Yong Xi 1, Yunhua Leng 2, Qun Wang

More information

Laparoscopic Repair of Incisional Hernia. Maria B. ALBUJA-CRUZ, MD University of Colorado Department of Surgery-Grand Rounds

Laparoscopic Repair of Incisional Hernia. Maria B. ALBUJA-CRUZ, MD University of Colorado Department of Surgery-Grand Rounds Laparoscopic Repair of Incisional Hernia Maria B. ALBUJA-CRUZ, MD University of Colorado Department of Surgery-Grand Rounds Overview Definition Advantages of Laparoscopic Repair Disadvantages of Open Repair

More information

Bowel Preparation for Colon Resection. Eric Klein, M.D. SUNY Downstate Department of Surgery

Bowel Preparation for Colon Resection. Eric Klein, M.D. SUNY Downstate Department of Surgery Bowel Preparation for Colon Resection Eric Klein, M.D. SUNY Downstate Department of Surgery Historical Perspective During World War II, failure to treat penetrating colon injuries with diversion could

More information

Endoscopic Management of Strictures and Leaks. Prepared by Aurora D. Pryor, MD Presented by Dana Portenier, MD Duke University Medical Center

Endoscopic Management of Strictures and Leaks. Prepared by Aurora D. Pryor, MD Presented by Dana Portenier, MD Duke University Medical Center Endoscopic Management of Strictures and Leaks Prepared by Aurora D. Pryor, MD Presented by Dana Portenier, MD Duke University Medical Center What can go wrong? Bleeding (2%) Sleeve too big Angulated Too

More information

NHS. Surgical repair of vaginal wall prolapse using mesh. National Institute for Health and Clinical Excellence. 1 Guidance.

NHS. Surgical repair of vaginal wall prolapse using mesh. National Institute for Health and Clinical Excellence. 1 Guidance. Issue date: June 2008 NHS National Institute for Health and Clinical Excellence Surgical repair of vaginal wall prolapse using mesh 1 Guidance 1.1 The evidence suggests that surgical repair of vaginal

More information

Danish national guidelines for treatment of diverticular

Danish national guidelines for treatment of diverticular CLINICAL GUIDELINES DANISH MEDICAL JOURNAL Danish national guidelines for treatment of diverticular disease Jens Christian Andersen, Lars Bundgaard, Henrik Elbrønd, Søren Laurberg, Line Rosell Walker,

More information

Dept. of Medical Imaging University of Ottawa

Dept. of Medical Imaging University of Ottawa ED Visits Related to Bariatric Surgery: Review of Normal Post-Surgical Anatomy as Well as Complications Dept. of Medical Imaging University of Ottawa Disclosures Background Roux-en-Y Gastric Bypass Surgery

More information

Revisional Bariatric Surgery

Revisional Bariatric Surgery Revisional Bariatric Surgery Todd Andrew Kellogg, MD KEYWORDS Bariatric surgery Revision Reoperation OVERVIEW With the increasing number of bariatric procedures being performed annually, it is expected

More information

Meta-analysis of randomized clinical trials of colorectal surgery with or without mechanical bowel preparation

Meta-analysis of randomized clinical trials of colorectal surgery with or without mechanical bowel preparation Meta-analysis Meta-analysis of randomized clinical trials of colorectal surgery with or without mechanical bowel preparation K. Slim 1,E.Vicaut 2,Y.Panis 3 and J. Chipponi 1 1 Department of General and

More information

Basic Laparoscopy and Lap. Suturing and Stapling course Course Contents

Basic Laparoscopy and Lap. Suturing and Stapling course Course Contents Online Courses on Laparoscopic GI Surgery for GISurgery.info Lap Skills course Harshad Soni 1. Basic Laparoscopy and Lap. Suturing and Stapling course H. Soni 2. Laparoscopic UGI Surgery Course J Mistry

More information

PREPARING FOR YOUR STOMA REVERSAL

PREPARING FOR YOUR STOMA REVERSAL PREPARING FOR YOUR STOMA REVERSAL Information Leaflet Your Health. Our Priority. Page 2 of 6 Introduction- What you need to know As part of your bowel operation you may have had a temporary stoma formed.

More information

Patient information regarding care and surgery associated with ULCERATIVE COLITIS

Patient information regarding care and surgery associated with ULCERATIVE COLITIS Patient information regarding care and surgery associated with ULCERATIVE COLITIS by: Robert K. Cleary, M.D., John C. Eggenberger, M.D., Amalia J. Stefanou, M.D. location: Michigan Heart & Vascular Institute,

More information

Clinical Practice Assessment Robotic surgery

Clinical Practice Assessment Robotic surgery Clinical Practice Assessment Robotic surgery Background: Surgery is by nature invasive. Efforts have been made over time to reduce complications and the trauma inherently associated with surgery through

More information

Why a loop and new approach makes sense!

Why a loop and new approach makes sense! IP: tomach Intestinal Pylorus paring urgery Why a loop and new approach makes sense! Mitchell Roslin, MD, FAC Chief of Bariatric and Metabolic urgery Lenox Hill Hospital Northern Westchester Hospital Center

More information

Outcomes and options in the management of leak and gastric fistula after sleeve gastrectomy.

Outcomes and options in the management of leak and gastric fistula after sleeve gastrectomy. Outcomes and options in the management of leak and gastric fistula after sleeve gastrectomy. 1 Mercy Bariatrics, Perth Australia Leon Cohen 1 Leak and gastric fistula after sleeve gastrectomy remains one

More information

BOWEL ANASTOMOSIS AND STOMAS

BOWEL ANASTOMOSIS AND STOMAS Surgery > Technical Scenario 8 BOWEL ANASTOMOSIS AND STOMAS MODULE: GENERAL SURGERY, UROLOGY TARGET: CT1 ST4 BACKGROUND: Bowel resection and anastomosis is a frequent occurrence during general surgical

More information

PANCREATIC AND PERIAMPULLARY TUMORS: PANCREATICODUODENECTOMY. Dr. Shailesh V. Shrikhande

PANCREATIC AND PERIAMPULLARY TUMORS: PANCREATICODUODENECTOMY. Dr. Shailesh V. Shrikhande PANCREATIC AND PERIAMPULLARY TUMORS: PANCREATICODUODENECTOMY Dr. Shailesh V. Shrikhande Associate Professor & Consultant Surgeon GI and HPB Surgical Oncology Tata Memorial Hospital, Mumbai INDIA HELICAL

More information

Laparoscopic Revisional Gastric Bypass after open bariatric surgeries. Haider Alshurafa 1

Laparoscopic Revisional Gastric Bypass after open bariatric surgeries. Haider Alshurafa 1 Laparoscopic Revisional Gastric Bypass after open bariatric surgeries 1 Surgery Department, Riyadh Military Hospital, Riyadh, Saudi Arabia Haider Alshurafa 1 Objective: To confirm the feasibility of the

More information

Informed Consent for Laparoscopic Vertical Sleeve Gastrectomy. Patient Name

Informed Consent for Laparoscopic Vertical Sleeve Gastrectomy. Patient Name Informed Consent for Laparoscopic Vertical Sleeve Gastrectomy Patient Name Please read this form carefully and ask about anything you may not understand. I consent to have a laparoscopic Vertical Sleeve

More information

PSA Screening for Prostate Cancer Information for Care Providers

PSA Screening for Prostate Cancer Information for Care Providers All men should know they are having a PSA test and be informed of the implications prior to testing. This booklet was created to help primary care providers offer men information about the risks and benefits

More information

Hemorrhoidectomy with LigaSure Small Jaw and Stapled Hemorrhoidopexy with EEA Hemorrhoid and Prolapse Stapler with DST

Hemorrhoidectomy with LigaSure Small Jaw and Stapled Hemorrhoidopexy with EEA Hemorrhoid and Prolapse Stapler with DST Hemorrhoidectomy with LigaSure Small Jaw and Stapled Hemorrhoidopexy with EEA Hemorrhoid and Prolapse Stapler with DST Dr. Wong Kutt Sing MBBS (S pore), FRCS (Edin), FRCS (Glas), FAMS General Surgery Raffles

More information

Open Ventral Hernia Repair

Open Ventral Hernia Repair Ventral Hernias Open Ventral Hernia Repair UCSF Postgraduate Course in General Surgery Maui, HI March 21, 2011 Hobart W. Harris, MD, MPH Ventral Hernias: National Experience Occur following 11-23% of laparotomies,

More information

Acute Abdominal Pain following Bariatric Surgery. Disclosure. Objectives 8/17/2015. I have nothing to disclose

Acute Abdominal Pain following Bariatric Surgery. Disclosure. Objectives 8/17/2015. I have nothing to disclose Acute Abdominal Pain following Bariatric Surgery Kathy J. Morris, DNP, APRN, FNP C, FAANP University of Nebraska Medical Center College of Nursing Disclosure I have nothing to disclose Objectives Pathophysiology

More information

The Evolution of Bariatric Surgery. History of the Development of a Successful Bariatric Program at the University of Iowa Hospitals & Clinics

The Evolution of Bariatric Surgery. History of the Development of a Successful Bariatric Program at the University of Iowa Hospitals & Clinics The Evolution of Bariatric Surgery History of the Development of a Successful Bariatric Program at the University of Iowa Hospitals & Clinics It s a BIG Problem & it s Getting Worse Obesity is now a disease

More information

Endoscopic therapy for obesity and complications of bariatric surgery

Endoscopic therapy for obesity and complications of bariatric surgery Endoscopic therapy for obesity and complications of bariatric surgery Jacques Devière, MD, PhD Erasme University Hospital Brussels Belgium jacques.deviere@erasme.ulb.ac.be Obesity Affects 300 millions

More information

The prognosis of gastrointestinal malignancies is strictly dependent on early detection of premalignant and malignant lesions

The prognosis of gastrointestinal malignancies is strictly dependent on early detection of premalignant and malignant lesions The prognosis of gastrointestinal malignancies is strictly dependent on early detection of premalignant and malignant lesions Early cancers in adenomatous lesions can be removed endoscopically (e.g. polypectomy,

More information

Surgical Management of Crohn s Disease. Aaron Winnick, M.D. Kings County Hospital Center SUNY Downstate Medical Center September 29, 2006

Surgical Management of Crohn s Disease. Aaron Winnick, M.D. Kings County Hospital Center SUNY Downstate Medical Center September 29, 2006 Surgical Management of Crohn s Disease Aaron Winnick, M.D. Kings County Hospital Center SUNY Downstate Medical Center September 29, 2006 Case Presentation xx yo female c/o abdominal pain x 1 month Epigastric

More information

Endoscopic gastric pouch plication - a novel endoluminal incision free approach to revisional bariatric surgery

Endoscopic gastric pouch plication - a novel endoluminal incision free approach to revisional bariatric surgery Endoscopic gastric pouch plication - a novel endoluminal incision free approach to revisional bariatric surgery Authors: Chiranjiv S Virk, I Michael Leitman and Elliot R Goodman. Location: Beth Israel

More information

Ulcerative colitis patients with low grade dysplasia should undergo frequent surveillance colonoscopies

Ulcerative colitis patients with low grade dysplasia should undergo frequent surveillance colonoscopies Ulcerative colitis patients with low grade dysplasia should undergo frequent surveillance colonoscopies David T. Rubin, MD, FACG, AGAF Associate Professor of Medicine Co-Director, Inflammatory Bowel Disease

More information

Colocutaneous Fistula. Disclosures

Colocutaneous Fistula. Disclosures Colocutaneous Fistula Madhulika G. Varma MD Associate Professor Chief, Colorectal Surgery University of California, San Francisco Honoraria Applied Medical Covidien Disclosures 1 Colocutaneous Fistula

More information

http://www.elsevier.com/locate/permissionusematerial

http://www.elsevier.com/locate/permissionusematerial This article was originally published in a journal published by Elsevier, and the attached copy is provided by Elsevier for the author s benefit and for the benefit of the author s institution, for non-commercial

More information

Introduction. Advantages of minimally invasive surgery (MIS) in pediatric trauma:

Introduction. Advantages of minimally invasive surgery (MIS) in pediatric trauma: Introduction Purpose of Study: To validate the use of laparoscopic and thoracoscopic surgery for diagnostic and therapeutic modalities in the treatment of pediatric trauma Advantages of minimally invasive

More information

The Whipple Procedure. Sally Hodges, Ph.D.(c) Given the length and difficulty of the procedure, regardless of the diagnosis, certain

The Whipple Procedure. Sally Hodges, Ph.D.(c) Given the length and difficulty of the procedure, regardless of the diagnosis, certain The Whipple Procedure Sally Hodges, Ph.D.(c) Preoperative procedures Given the length and difficulty of the procedure, regardless of the diagnosis, certain assurances must occur prior to offering a patient

More information

Does Selenium protect against lung cancer? Do Selenium supplements reduce the incidence of lung cancer in healthy individuals?

Does Selenium protect against lung cancer? Do Selenium supplements reduce the incidence of lung cancer in healthy individuals? Does Selenium protect against lung cancer? Do Selenium supplements reduce the incidence of lung cancer in healthy individuals? Alexander Blakes and Eleanor Brunt October 2014 The question Mr Wilson s father

More information

Sleeve gastrectomy or gastric bypass as revisional bariatric procedures: retrospective evaluation of outcomes. Abstract Background Methods:

Sleeve gastrectomy or gastric bypass as revisional bariatric procedures: retrospective evaluation of outcomes. Abstract Background Methods: Sleeve gastrectomy or gastric bypass as revisional bariatric procedures: retrospective evaluation of outcomes. Mousa Khoursheed, Ibtisam Al-Bader, Ali Mouzannar, Abdulla Al-Haddad, Ali Sayed, Ali Mohammad,

More information

linear stapler a better life trough innovative surgical technology primary status semi-closed status fully-closed status post-firing status

linear stapler a better life trough innovative surgical technology primary status semi-closed status fully-closed status post-firing status a better life trough innovative surgical technology linear stapler Unique safety feature! The color indicator window shows different colors for different firing phases and reduces the possibility of misoperation.

More information

Laparoscopic Surgery of the Colon and Rectum (Large Intestine) A Simple Guide to Help Answer Your Questions

Laparoscopic Surgery of the Colon and Rectum (Large Intestine) A Simple Guide to Help Answer Your Questions Laparoscopic Surgery of the Colon and Rectum (Large Intestine) A Simple Guide to Help Answer Your Questions What are the Colon and Rectum? The colon and rectum together make up the large intestine. After

More information

When, Why, and How to Revise a Failed Sleeve Gastrectomy

When, Why, and How to Revise a Failed Sleeve Gastrectomy When, Why, and How to Revise a Failed Sleeve Gastrectomy Jin S. Yoo M.D. Assistant Professor of Surgery Duke University Medical Center April 6, 2013 When and Why Already Covered Let s Talk About How Overview

More information

Peritoneal Surface Malignancies. Ira Allen Jacobs, MD, FACS Surgical Oncology San Diego, CA

Peritoneal Surface Malignancies. Ira Allen Jacobs, MD, FACS Surgical Oncology San Diego, CA Peritoneal Surface Malignancies Ira Allen Jacobs, MD, FACS Surgical Oncology San Diego, CA Cancer dissemination routes Hematogenous metastases Lymphatic metastases Implants on peritoneal surfaces Surgically

More information

Physician. Patient COLECTOMY COLECTOMY. Treatment Options Risks and Benefits Experience and Skill

Physician. Patient COLECTOMY COLECTOMY. Treatment Options Risks and Benefits Experience and Skill COLECTOMY Physician Treatment Options Risks and Benefits Experience and Skill Patient Personal Preferences Values and Concerns Lifestyle Choices Shared Decision Making A process of open communication.

More information

Ileorectal anastomosis in Ulcerative Colitis The better option?

Ileorectal anastomosis in Ulcerative Colitis The better option? Ileorectal anastomosis in Ulcerative Colitis The better option? Pär Myrelid MD, PhD Department of Surgery, Unit of Colorectal Surgery Linköping University Hospital Linköping Sweden October 11, 2012 Bowel

More information

AMERICAN COLLEGE OF SURGEONS DIVISION OF EDUCATION. The Condition

AMERICAN COLLEGE OF SURGEONS DIVISION OF EDUCATION. The Condition AMERICAN COLLEGE OF SURGEONS DIVISION OF EDUCATION Surgical Removal of the Ascending Digestive System Rectum Anus Transverse Patient Education This educational information is to help you be better informed

More information

Urinary Diversion: Ileovesicostomy/Ileal Loop/Colon Loop

Urinary Diversion: Ileovesicostomy/Ileal Loop/Colon Loop Urinary Diversion: Ileovesicostomy/Ileal Loop/Colon Loop Why do I need this surgery? A urinary diversion is a surgical procedure that is performed to allow urine to safely pass from the kidneys into a

More information

Omega-3 fatty acids improve the diagnosis-related clinical outcome. Critical Care Medicine April 2006;34(4):972-9

Omega-3 fatty acids improve the diagnosis-related clinical outcome. Critical Care Medicine April 2006;34(4):972-9 Omega-3 fatty acids improve the diagnosis-related clinical outcome 1 Critical Care Medicine April 2006;34(4):972-9 Volume 34(4), April 2006, pp 972-979 Heller, Axel R. MD, PhD; Rössler, Susann; Litz, Rainer

More information

7. Prostate cancer in PSA relapse

7. Prostate cancer in PSA relapse 7. Prostate cancer in PSA relapse A patient with prostate cancer in PSA relapse is one who, having received a primary treatment with intent to cure, has a raised PSA (prostate-specific antigen) level defined

More information

Evidence of Crohn s Disease. Case Presentation

Evidence of Crohn s Disease. Case Presentation Witt Wait to Treat tutiled Until Endoscopic Evidence of Crohn s Disease Raymond Cross, MD, MS, AGAF Associate Professor of Medicine Director, IBD Program University of Maryland School of Medicine Co-Director,

More information

9/26/14. Joel E. Rand, MPAS, PA-C DMU Luncheon May 1, 2014

9/26/14. Joel E. Rand, MPAS, PA-C DMU Luncheon May 1, 2014 Joel E. Rand, MPAS, PA-C DMU Luncheon May 1, 2014 No financial relationship or commercial interest in any of the technologies discussed Not supporting any non-fda off label uses of any product or service

More information

EAES course on Advanced Laparoscopic GI Surgery Course. Riyadh, Saudi Arabia 10-14 January 2015

EAES course on Advanced Laparoscopic GI Surgery Course. Riyadh, Saudi Arabia 10-14 January 2015 EAES course on Advanced Laparoscopic GI Surgery Course Riyadh, Saudi Arabia 10-14 January 2015 The European Association for Endoscopic Surgery and King Khalid University Hospital, Riyadh, Saudi Arabia

More information

Cancer research in the Midland Region the prostate and bowel cancer projects

Cancer research in the Midland Region the prostate and bowel cancer projects Cancer research in the Midland Region the prostate and bowel cancer projects Ross Lawrenson Waikato Clinical School University of Auckland MoH/HRC Cancer Research agenda Lung cancer Palliative care Prostate

More information

Profiling surgical staplers: effect of staple height, buttress, and overlap on staple line failure

Profiling surgical staplers: effect of staple height, buttress, and overlap on staple line failure Surgery for Obesity and Related Diseases 4 (2008) 416 422 Original article Profiling surgical staplers: effect of staple height, buttress, and overlap on staple line failure Carlos M. Mery, M.D., M.P.H.

More information

Study Design Of Medical Research

Study Design Of Medical Research Study Design Of Medical Research By Ahmed A.Shokeir, MD,PHD, FEBU Prof. Urology, Urology & Nephrology Center, Mansoura, Egypt Study Designs In Medical Research Topics Classification Case series studies

More information

Plumbing 101:! TXA and EMS! Jay H. Reich, MD FACEP! EMS Medical Director! City of Kansas City, Missouri/Kansas City Fire Department!

Plumbing 101:! TXA and EMS! Jay H. Reich, MD FACEP! EMS Medical Director! City of Kansas City, Missouri/Kansas City Fire Department! Plumbing 101:! TXA and EMS! Jay H. Reich, MD FACEP! EMS Medical Director! City of Kansas City, Missouri/Kansas City Fire Department! EMS Section Chief! Department of Emergency Medicine! University of Missouri-Kansas

More information

Get the Facts, Be Informed, Make YOUR Best Decision. Pelvic Organ Prolapse

Get the Facts, Be Informed, Make YOUR Best Decision. Pelvic Organ Prolapse Pelvic Organ Prolapse ETHICON Women s Health & Urology, a division of ETHICON, INC., a Johnson & Johnson company, is dedicated to providing innovative solutions for common women s health problems and to

More information

Epinephrine in CPR. The 5 Most Important EMS Articles EAGLES 2014. Epi vs No-Epi Take Homes 2/28/2014. VF/VT (1990 Pairs) Epi vs No-Epi

Epinephrine in CPR. The 5 Most Important EMS Articles EAGLES 2014. Epi vs No-Epi Take Homes 2/28/2014. VF/VT (1990 Pairs) Epi vs No-Epi The 5 Most Important EMS Articles EAGLES 214 Corey M. Slovis, M.D. Vanderbilt University Medical Center Metro Nashville Fire Department Nashville International Airport Nashville, TN nephrine in CPR VF/VT

More information

Definition(s) of Diverticular Disease

Definition(s) of Diverticular Disease Falk-Symposium 148 "Divertikelkrankheit: Neue Erkenntnisse einer Volkskrankheit" München; 17.-18. Juni 2005; Session II 11:15-12:20 Definition(s) of Diverticular Disease Prof. Edmund Neugebauer, Dr. J.

More information

Assessment Day Bariatric Surgery. 12266 DePaul Drive, Suite 310 Bridgeton, MO 63044 (P) 1-877-477-6954 ssmweightloss.com

Assessment Day Bariatric Surgery. 12266 DePaul Drive, Suite 310 Bridgeton, MO 63044 (P) 1-877-477-6954 ssmweightloss.com Assessment Day Bariatric Surgery 12266 DePaul Drive, Suite 310 Bridgeton, MO 63044 (P) 1-877-477-6954 ssmweightloss.com Assessment Day Agenda Types of Surgery Complications Expectations Next Steps Questions

More information

INGUINAL HERNIA REPAIR Actual Status ---------------------------------------

INGUINAL HERNIA REPAIR Actual Status --------------------------------------- INGUINAL HERNIA REPAIR Actual Status Prof. Dr. R.Van Hee University of Antwerp Belgium European Academy of Surgical Sciences INGUINAL HERNIA REPAIR - ACTUAL STATUS (Abstract): Even in in 2006, there are

More information

The 5 Most Important EMS Articles EAGLES 2014

The 5 Most Important EMS Articles EAGLES 2014 The 5 Most Important EMS Articles EAGLES 2014 Corey M. Slovis, M.D. Vanderbilt University Medical Center Metro Nashville Fire Department Nashville International Airport Nashville, TN VanderbiltEM.com

More information

Bridging Techniques. What s between EMR and Traditional Surgery? Elisabeth C. McLemore, MD, FACS, FASCRS

Bridging Techniques. What s between EMR and Traditional Surgery? Elisabeth C. McLemore, MD, FACS, FASCRS Bridging Techniques What s between EMR and Traditional Surgery? Elisabeth C. McLemore, MD, FACS, FASCRS Associate Professor of Surgery Assistant Program Director, General Surgery Residency Disclosures

More information

Tips for surviving the analysis of survival data. Philip Twumasi-Ankrah, PhD

Tips for surviving the analysis of survival data. Philip Twumasi-Ankrah, PhD Tips for surviving the analysis of survival data Philip Twumasi-Ankrah, PhD Big picture In medical research and many other areas of research, we often confront continuous, ordinal or dichotomous outcomes

More information

Weight Loss Surgery Info for Physicians

Weight Loss Surgery Info for Physicians Weight Loss Surgery Info for Physicians As physicians, we see it every day when we see our patients more and more people are obese, and it s affecting their health. It s estimated that at least 2/3 of

More information

Cancer of the Cardia/GE Junction: Surgical Options

Cancer of the Cardia/GE Junction: Surgical Options Cancer of the Cardia/GE Junction: Surgical Options Michael A Smith, MD Associate Chief Thoracic Surgery Center for Thoracic Disease St Joseph s Hospital and Medical Center Phoenix, AZ Michael Smith, MD

More information

2/21/2016. Prolapse Surgery after Transvaginal Mesh: The Evolving Landscape. Disclosures. Objectives. No Relevant Disclosures

2/21/2016. Prolapse Surgery after Transvaginal Mesh: The Evolving Landscape. Disclosures. Objectives. No Relevant Disclosures Prolapse Surgery after Transvaginal Mesh: The Evolving Landscape David R. Ellington, MD, FACOG Assistant Professor Division of Urogynecology and Pelvic Reconstructive Surgery Disclosures No Relevant Disclosures

More information

11/4/2014. Colon Cancer. Han Koh, MD Medical Oncology Downey Kaiser. 2 nd overall leading cause of cancer death in the United States.

11/4/2014. Colon Cancer. Han Koh, MD Medical Oncology Downey Kaiser. 2 nd overall leading cause of cancer death in the United States. Colon Cancer Han Koh, MD Medical Oncology Downey Kaiser 2 nd overall leading cause of cancer death in the United States 3 rd in each sex Approximately 6% of individuals in the US will develop a cancer

More information

Colon Cancer. About the Colon and Rectum. Symptoms. Colorectal Cancer Screening

Colon Cancer. About the Colon and Rectum. Symptoms. Colorectal Cancer Screening Patient information regarding care and surgery associated with COLON CANCER by Robert K. Cleary, M.D., John C. Eggenberger, M.D., Amalia J. Stefanou., M.D. location: Michigan Heart and Vascular Institute,

More information

Endoluminal Bariatric Revision. Todd David Wilson, MD

Endoluminal Bariatric Revision. Todd David Wilson, MD Endoluminal Bariatric Revision Todd David Wilson, MD Surgical Endoscopy and the Bariatric Surgeon Preoperative Endoscopy Postoperative Endoscopy Revisional Endoscopy Primary Endoluminal Bariatrics Preoperative

More information

Anterior Resection Your Operation Explained

Anterior Resection Your Operation Explained Anterior Resection Your Operation Explained Patient Information Introduction This leaflet tells you about the procedure known as an anterior resection. It explains what is involved, and some of the common

More information

Epi procolon The Blood Test for Colorectal Cancer Screening

Epi procolon The Blood Test for Colorectal Cancer Screening Epi procolon The Blood Test for Colorectal Cancer Screening Epi procolon is an approved blood test for colorectal cancer screening. The US Preventive Services Task Force, the American Cancer Society and

More information

Effects of Pregnancy & Delivery on Pelvic Floor

Effects of Pregnancy & Delivery on Pelvic Floor Effects of Pregnancy & Delivery on Pelvic Floor 吳 銘 斌 M.D., Ph.D. 財 團 法 人 奇 美 醫 院 婦 產 部 婦 女 泌 尿 暨 骨 盆 醫 學 科 ; 台 北 醫 學 大 學 醫 學 院 婦 產 學 科 ; 古 都 府 城 台 南 Introduction Pelvic floor disorders (PFDs) include

More information

Informed Consent for Laparoscopic Roux en Y Gastric Bypass. Patient Name

Informed Consent for Laparoscopic Roux en Y Gastric Bypass. Patient Name Informed Consent for Laparoscopic Roux en Y Gastric Bypass Patient Name Please read this form carefully and ask about anything you may not understand. I consent to have a laparoscopic Roux en Y Gastric

More information

Laparoscopic Trainer Product Catalog

Laparoscopic Trainer Product Catalog Laparoscopic Trainer Product Catalog Laparoscopic Trainer Product Catalog Simsei Table of Contents Laparoscopic Trainers 6 Organ Models 8 Skill Exercises 11 Accessories 12 Additional Information About

More information

Curriculum Vitae. Ovunc Bardakcioglu, M.D. Undergraduate degree and major, university and date

Curriculum Vitae. Ovunc Bardakcioglu, M.D. Undergraduate degree and major, university and date 1 Revised 3/1/12 Curriculum Vitae Ovunc Bardakcioglu, M.D. Education: Undergraduate degree and major, university and date 1990-1993 Kreuzgasse Gymnasium Cologne, Germany Abitur (Bachelor), Biology and

More information

Glossary of Methodologic Terms

Glossary of Methodologic Terms Glossary of Methodologic Terms Before-After Trial: Investigation of therapeutic alternatives in which individuals of 1 period and under a single treatment are compared with individuals at a subsequent

More information

The Arguments: T2DM - tremendous economic burden globally Lifestyle / Pharm Rx:

The Arguments: T2DM - tremendous economic burden globally Lifestyle / Pharm Rx: James Cromie The Arguments: T2DM - tremendous economic burden globally Lifestyle / Pharm Rx: INEFFECTIVE and UNSUSTAINED Bariatric surgery is an Effective and Durable treatment option Well established

More information

New Anticoagulants and GI bleeding

New Anticoagulants and GI bleeding New Anticoagulants and GI bleeding DR DANNY MYERS MD FRCP(C) CLINICAL ASSISTANT PROFESSOR OF MEDICINE, UBC Conflicts of Interest None I am unbiased in the use of NOAC s vs Warfarin based on risk benefit

More information

PREVENTION OF HCC BY HEPATITIS C TREATMENT. Morris Sherman University of Toronto

PREVENTION OF HCC BY HEPATITIS C TREATMENT. Morris Sherman University of Toronto PREVENTION OF HCC BY HEPATITIS C TREATMENT Morris Sherman University of Toronto Pathogenesis of HCC in chronic hepatitis C Injury cirrhosis HCC Injury cirrhosis HCC Time The Ideal Study Prospective randomized

More information

Early Colonoscopy in Patients with Acute Diverticulitis Simon Bar-Meir, M.D.

Early Colonoscopy in Patients with Acute Diverticulitis Simon Bar-Meir, M.D. Early Colonoscopy in Patients with Acute Diverticulitis Simon Bar-Meir, M.D. Professor of Medicine Germanis Kaufman Chair of Gastroenterology Director, Dept. of Gastroenterology Chaim Sheba Medical Center,

More information

A Passive RFID Implant for Soft Tissue Trauma Monitoring

A Passive RFID Implant for Soft Tissue Trauma Monitoring A Passive RFID Implant for Soft Tissue Trauma Monitoring J.M. Rigelsford and C. J. Davenport Department of Electronic & Electrical Engineering, The University of Sheffield, Sheffield, S1 3JD, UK Background

More information

Opportunistic Infections Related to Immune Suppressant and Biologic Drug Therapy in IBD

Opportunistic Infections Related to Immune Suppressant and Biologic Drug Therapy in IBD Opportunistic Infections Related to Immune Suppressant and Biologic Drug Therapy in IBD Raymond Cross, M.D., M.S., AGAF Associate Professor of Medicine Director of the Inflammatory Bowel Disease Program

More information

PHaSES: Practical Hands-on Surgical Education System

PHaSES: Practical Hands-on Surgical Education System U.S. Toll Free 866-GOLIMBS PHaSES Range PHaSES: Practical Hands-on Surgical Education System Limbs & Things is pleased to introduce the PHaSES Range. The range is based upon our well known basic & general

More information

Bariatric i Surgery: Optimalizing Outcome Results. Dr. B. Dillemans AZ Sint-Jan AV Brugge-Oostende BARIATRIC SURGERY

Bariatric i Surgery: Optimalizing Outcome Results. Dr. B. Dillemans AZ Sint-Jan AV Brugge-Oostende BARIATRIC SURGERY Bariatric i Surgery: Optimalizing i Outcome Results Dr. B. Dillemans AZ Sint-Jan AV Brugge-Oostende THE OBESE PATIENT : A CHALLENGE FOR ANAESTHESIA, Ostend,14/11/09 BARIATRIC SURGERY 50 s : First Reported

More information

INGUINAL HERNIA REPAIR BY DARNING

INGUINAL HERNIA REPAIR BY DARNING INGUINAL HERNIA REPAIR BY DARNING BinBisher Saeed A. MD, FICMS Barabba Rabea MD, JBS Diffel and matrix functions INGUINAL HERNIA REPAIR BY DARNING BinBisher Saeed A. MD, FICMS Barabba Rabea MD, JBS INTRODUCTION

More information

BAISHIDENG PUBLISHING GROUP INC

BAISHIDENG PUBLISHING GROUP INC Reviewer s code: 01714224 Reviewer s country: Italy Date reviewed: 2015-01-30 20:36 [ Y] Grade A: Priority publishing [ ] Accept [ ] Grade C: Good [ Y] Grade D: Fair language [ Y] Major revision The article

More information

Journal reading. Method. Introduction. Measurement. Supervisor: F1 徐 英 洲 Presentor:R1 劉 邦 民 103.04.14

Journal reading. Method. Introduction. Measurement. Supervisor: F1 徐 英 洲 Presentor:R1 劉 邦 民 103.04.14 Journal reading Supervisor: F1 徐 英 洲 Presentor:R1 劉 邦 民 103.04.14 Introduction Epinephrine usage in CPR Pro: Ability to augment BP and increased coronary perfusion through systemic vasoconstriction Cons:

More information

ABThera Open Abdomen Negative Pressure Therapy for Active Abdominal Therapy. Case Series

ABThera Open Abdomen Negative Pressure Therapy for Active Abdominal Therapy. Case Series ABThera Open Abdomen Negative Pressure Therapy for Active Abdominal Therapy Case Series Summary of Cases: USER EXPERIENCE The ABThera OA NPT system was found by surgeons to be a convenient and effective

More information

How To Perform Da Vinci Surgery

How To Perform Da Vinci Surgery Facing a Hysterectomy? If you ve been diagnosed with early stage gynecologic cancer, learn about minimally invasive da Vinci Surgery The Condition: Early Stage Gynecologic Cancer A variety of gynecologic

More information

Sigmoid Colectomy Your Operation Explained

Sigmoid Colectomy Your Operation Explained Sigmoid Colectomy Your Operation Explained Patient Information Information for patients This leaflet tells you about the procedure known as a sigmoid colectomy. It explains what is involved, and some of

More information

Oxford University Hospitals

Oxford University Hospitals Oxford University Hospitals NHS Trust Department of Hepatobiliary and Pancreatic Surgery About Pancreatic Surgery A guide for patients and relatives Introduction This booklet has been written to provide

More information

Surgical Site Infection Prevention

Surgical Site Infection Prevention Surgical Site Infection Prevention 1 Objectives 1. Discuss risk factors for SSI 2. Describe evidence-based best practices for SSI prevention 3. State principles of antibiotic prophylaxis 4. Discuss novel

More information

Early jejunojejunostomy obstruction after laparoscopic gastric bypass: case series and treatment algorithm

Early jejunojejunostomy obstruction after laparoscopic gastric bypass: case series and treatment algorithm Surgery for Obesity and Related Diseases 5 (2009) 203 207 Original article Early jejunojejunostomy obstruction after laparoscopic gastric bypass: case series and treatment algorithm Catherine E. Lewis,

More information

Endoscopy and infection: Prevention of infection during endoscopy Treatment of infection by endoscopy. M. Arvanitakis SRBG June 2009

Endoscopy and infection: Prevention of infection during endoscopy Treatment of infection by endoscopy. M. Arvanitakis SRBG June 2009 Endoscopy and infection: Prevention of infection during endoscopy Treatment of infection by endoscopy M. Arvanitakis SRBG June 2009 Outline Antibiotic prophylaxis during endoscopy Upper GI endoscopy Lower

More information

Complications that may occur with ulcerative colitis:

Complications that may occur with ulcerative colitis: Ulcerative Colitis What is ulcerative colitis? Ulcerative colitis is one of the major forms of inflammatory bowel disease. The other major form is Crohn s disease. Ulcerative colitis is felt to be due

More information

Restricted permission granted by the American Society for Parenteral and Enteral Nutrition (A.S.P.E.N.) from the following: Journal of Parenteral and

Restricted permission granted by the American Society for Parenteral and Enteral Nutrition (A.S.P.E.N.) from the following: Journal of Parenteral and Restricted permission granted by the American Society for Parenteral and Enteral Nutrition (A.S.P.E.N.) from the following: Journal of Parenteral and ENteral Nutrition (JPEN); Canadian Clinical Practice

More information

Management of Peritoneal Metastases (PM) from colorectal cancers: New Perspectives. Dominique ELIAS

Management of Peritoneal Metastases (PM) from colorectal cancers: New Perspectives. Dominique ELIAS Management of Peritoneal Metastases (PM) from colorectal cancers: New Perspectives Dominique ELIAS Declaration of interest BOARDS Congress and teaching 0 Merck 0 Ipsen Novartis Sanofi Trials The peritoneum

More information

The Science behind Proton Beam Therapy

The Science behind Proton Beam Therapy The Science behind Proton Beam Therapy Anthony Zietman MD Shipley Professor of Radiation Oncology Massachusetts General Hospital Harvard Medical School Principles underlying Radiotherapy Radiation related

More information

Technical Aspects of Bariatric Surgical Procedures. Robert O. Carpenter, MD, MPH, FACS Department of Surgery Scott & White Memorial Hospital

Technical Aspects of Bariatric Surgical Procedures. Robert O. Carpenter, MD, MPH, FACS Department of Surgery Scott & White Memorial Hospital Technical Aspects of Bariatric Surgical Procedures Robert O. Carpenter, MD, MPH, FACS Department of Surgery Scott & White Memorial Hospital Disclosures Allergan, Inc. (Past) Faculty Member Educational

More information

Utilizing Evidence Based Outcome Measures to Develop Practice Management Guidelines: A Primer

Utilizing Evidence Based Outcome Measures to Develop Practice Management Guidelines: A Primer Utilizing Evidence Based Outcome Measures to Develop Practice Management Guidelines: A Primer Eastern Association for the Surgery of Trauma (EAST) Ad Hoc Committee on Practice Management Guideline Development

More information

Imaging of Thoracic Endovascular Stent-Grafts

Imaging of Thoracic Endovascular Stent-Grafts Imaging of Thoracic Endovascular Stent-Grafts Tariq Hameed, M.D. Department of Radiology and Imaging Sciences, Indiana University School of Medicine, Indianapolis, Indiana Disclosures: No relevant financial

More information

Retrospective Review of Intra Abdominal Injuries Sustained in a Tertiary Teaching Hospital

Retrospective Review of Intra Abdominal Injuries Sustained in a Tertiary Teaching Hospital American Journal of Medicine and Medical Sciences 2015, 5(1): 26-30 DOI: 10.5923/j.ajmms.20150501.06 Retrospective Review of Intra Abdominal Injuries Sustained in a Tertiary Teaching Hospital Azhar Amir

More information